Asymptomatic Wolff-Parkinson-White Syndrome with High-Risk Findings on Electrophysiology Study

Not all asymptomatic patients with ventricular pre-excitation carry the same risk. When electrophysiology testing identifies specific high-risk accessory pathway properties, a defined management pathway applies — regardless of symptoms.

Clinical Scenario

Asymptomatic ventricular pre-excitation in a patient where electrophysiology study — including provocation with isoprenaline — reveals one or more of the following high-risk properties:

Shortest pre-excited RR interval during atrial fibrillation ≤250 ms
Accessory pathway effective refractory period ≤250 ms
Multiple accessory pathways
Inducible accessory pathway-mediated tachycardia

Management Approach

A catheter-based intervention targeting the accessory pathway is the recommended strategy in this high-risk electrophysiology profile. The full structured protocol — including procedural criteria and evidence grading — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehz467

Catheter ablation is recommended in asymptomatic patients in whom electrophysiology testing with the use of isoprenaline identifies high-risk properties, such as SPERRI ≤250 ms, AP ERP ≤250 ms, multiple APs, and an inducible AP-mediated tachycardia.

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